Doorstop - Dr Kerryn Phelps, AMA President with peak GP organisations - the ADGP; the RACGP and the RDAA, Canberra - Government's Medicare Package

1 May 2003

E & OE - Proof Only

DR PHELPS: Good afternoon everyone. We've just emerged from a meeting of the leaders of the general practice groups representing the Australian Medical Association, the Royal Australian College of General Practitioners, the Australian Divisions of General Practice, and the Rural Doctors' Association.

I'm joined by representatives of those groups. I have Claire Jackson, a GP from Queensland, Ken Mackay - well known to you as the President of the Rural Doctors' Association. Glad Mattick, a GP from Walgett, and also with the Australian Divisions of General Practice. Rob Walters, who is the Chair of the Australian Divisions of General Practice, and David Rivett, who is the Chair of the Australian Medical Association Council of General Practice.

Australian general practice is in crisis, and has been for some time. The GP leaders of Australia's general practice groups do not believe that the Government's package will address the very serious concerns about workforce shortage, access, and affordability to general practice in Australia. We think there are a number of potential positive elements to this package, but most of those positives come with strings attached, which we believe that the majority of general practices would find unacceptable.

Now, we have comments that can be made by my colleagues that are surrounding me, so I will hand over to the College for a comment.

DR CLAIRE JACKSON: The College welcomes the Government's recognition that the general practice workforce is in crisis, but we believe that this is a band-aid solution only, and will not go a long way toward solving the many problems we have in sustaining affordable quality general practice for all Australians.

DR KEN MACKAY: From our Rural Doctors' perspective, we certainly agree with all the GP groups that this isn't the solution for what is needed for Medicare, what is needed for good health. But from the Rural Doctors' perspective a lot of the advantages and the benefits from this package certainly look a little bit more positive.

Certainly the workforce issues to do with the extra number of doctors coming into the rural area - we certainly appreciate the recognition, but we look forward to more tinkering with this system of Medicare to make sure it improves both for our rural doctors and for our urban doctors as well.

DR ROB WALTERS: There's a large number of measures in this package that could potentially be very good. The problem is that we have an element of compulsion, that will compel doctors to either opt in or opt out, and we don't believe that this is the best interests of our patients, or indeed of our membership, the doctors.

QUESTION: Is the general agreement that the basic scheduled fee is the problem?

DR PHELPS: There's no question that a deficient Medicare benefit schedule that has been allowed to rot for the last two or three decades is the underlying problem facing general practice - that general practitioners have tried to do all they can by compromising things behind the scenes - things like when they update their waiting room furniture, computerisation, accreditation costs - they have tried to provide as much of a quality patient service to the patients as they possibly can, and have sacrificed - in many extents - to - in many instances the viability of their practices.

It gets to a point where GPs will refuse to compromise patient care and the quality of that care. The time that they're able to spend with patients. They would rather pack up and move on somewhere else or find another career. Or just close up their practices.

Now, this is one of the tragedies that is facing the Australian community and we don't want to see a situation where Australian patients who need a doctor can't access a doctor in time. We don't believe that this package provides a solution to that building problem.

QUESTION: Will GPs boycott the deal?

DR ROB WALTERS: I believe the GPs will make up their mind, dependent upon their circumstances. You've got to understand that GPs are desperately trying to meet the needs of the community and survive as a business. General Practice is the same as any other little business. We pay rent, we pay staff, we pay power bill, and we are under-funded.

For far too long the fundamental health system has relied on the altruism of general practitioners, of general practitioners being prepared to forego a few bucks to help someone out. It can't go on any longer.

QUESTION: Do you propose to go back to the Government with a proposal as to how you might move forward?

DR PHELPS: We've had an extensive meeting this afternoon with Jane Halton, the head of the Department of Health.

QUESTION: Did she address all of you?

DR PHELPS: Yes. And we met together for a considerable length of time. We were able to relay all of our concerns to Ms Halton and she has given us an undertaking that she will take those concerns back to Government. It's not clear how much of this package is negotiable at this stage.

Certainly the messages that we're getting is that it's largely not negotiable. And then, at the end of the day, it will be up to GPs to decide whether it's worth their while to opt in or not to opt in. And at the end of the day, once again, patients may well find that they are not able to access bulk billing, perhaps at the same rate that they were before because practices simply can't afford to bulk bill at the same rates that they could before.

QUESTION: The Health Minister has said that if doctors don't opt into the scheme they're likely to face patient pressure to do so. They'll ask, well, why can't you bulk bill your pensioner patients, the Government's offering more money. What could doctors say to that?

ROB WALTERS: I think that patients have a very special relationship with their general practitioner that perhaps people who aren't involved in the industry don't recognise. And I believe that they value the service that they get from general practitioners.

DR DAVID RIVETT: Patients are going to look at a dollar contribution from Government and say you've got to be joking, Mr Prime Minister, this is too little too late. This isn't gonna sustain quality care. One dollar doesn't even buy a newspaper. I mean this is nonsense.

DR CLAIRE JACKSON: Our organisations are well aware of the pain that Australians are feeling at the moment in trying to access general practice, and we've agreed to work together to look to a solution. If this isn't it, we need to actually get behind it with Government so that we do have a viable industry.

QUESTION: Did Jane Halton offer any more, anything different or more to you today?

DR PHELPS: No, she listened to what we had to say but I don't think was in a position to offer anything other than the fact that she would take the message back to Government and tell them how strongly general practitioners were feeling about this package.

QUESTION: With most of the Senate parties seemingly opposed to the package, does that put you in a strong arguing position to perhaps gain some further leeway from the Government?

DR PHELPS: I think that it will be interesting to see what the Senate does with this. Certainly we wouldn't like to see the baby thrown out with the bath water and have the Senate perhaps put through things that would be incredibly unpopular with general practitioners and patients for political motives. And so we will no doubt be having further discussions with the Opposition parties as well.

DR KEN MACKEY: We've got to make sure that from the rural perspective we maintain the benefits that have been put into this package. We have got some extra benefits out of the package, over and above what has been offered for the urban areas. And whatever is done for Medicare and the changes to Medicare we want to make sure that the special recognition is there for our rural patients, for our rural doctors. And hopefully that's going to be forthcoming in any changes that come forward.

ROB WALTERS: It's about time we got to the stage in this country where primary health care was above politics and above philosophical arguments. Patients out there are getting very good quality primary health care from GPs in this country, but you won't have GPs within the short future.

DAVID RIVETT: Last year the training scheme places couldn't be filled. GPs - general practice - is becoming singularly unattractive as a career path. People will go to other specialties or out of medicine altogether. I mean it's got to be made attractive once again. We've got to get numbers of GPs, it doesn't address it in any way.

DR PHELPS: One of the really insidious elements of this package is that it recognises the workforce crisis, it recognises that we need more medical students and that we need more training general practitioners. Unfortunately what it does is that it shackles those people. First of all it bonds the medical students for six years and the GP registrar places were unable to be filled last year.

And so, by having more places - 150 more places - yes, we welcome that, but are the doctors going to be there to take it up? And is there enough in this package for young graduates to say general practice has so much to offer me - and indeed it does, in terms of a career option - but putting more hurdles in the way, and putting more bonding and more shackles on people who are wanting to work in general practice is not the way to encourage bright young graduates to enter into general practice as a specialty.

Thank you all.


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